Reducing seed waste and increasing value of dynamic intraoperative implantation of Pd‐103 seeds in prostate brachytherapy

Several nomograms exist for ordering palladium‐103 seeds for permanent prostate seed implants (PSI). Excess seeds from PSIs pose additional radiation safety risks and increase the cost of care. This study compared five nomograms to clinical data from dynamic modified‐peripheral intraoperative PSI to...

Full description

Saved in:
Bibliographic Details
Published in:Journal of applied clinical medical physics 2018-09, Vol.19 (5), p.383-388
Main Authors: Taylor, Peter K., Riegel, Adam C.
Format: Article
Language:English
Subjects:
Authorship
Brachytherapy
Cancer therapies
Cost control
Dosimetry
Drug dosages
Humans
Iodine Radioisotopes
Isotopes
Male
nomogram
Nomograms
Palladium
palladium‐103
Patients
Professional relationships
Prostate cancer
prostate seed implant
Prostatic Neoplasms - radiotherapy
Radiation Oncology Physics
Radiation therapy
Radiotherapy Dosage
Retrospective Studies
Seeds
Transplants & implants
Ultrasonic imaging
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Several nomograms exist for ordering palladium‐103 seeds for permanent prostate seed implants (PSI). Excess seeds from PSIs pose additional radiation safety risks and increase the cost of care. This study compared five nomograms to clinical data from dynamic modified‐peripheral intraoperative PSI to determine (a) the cause of excess seeds and (b) the optimal nomogram for our institution. Pre‐ and intraoperative patient data were collected for monotherapy PSIs and compiled into a clinical database. All patients were prescribed 125 Gy with dose coverage of D90% = 100% to the planning target volume (PTV) using 103Pd seeds with mean air‐kerma strength (SK¯) of 2 U. Seeds were ordered based upon an in‐house nomogram as a function of preoperative prostate volume and prescription dose. Preoperative prostate volume was assessed with transrectal ultrasound. If any of the following four conditions were not met: (a) preoperative volume = intraoperative volume, (b) D90% = 100%, (c) SK¯=2U, and (d) seed ordering matched the in‐house nomogram, then a normalization factor was applied to the number of seeds used intraoperatively to meet all four conditions. Four published nomograms, an in‐house nomogram, and the normalized number of implanted seeds for each patient were plotted against intraoperative prostate volume. Of the 226 patients, 223 had excess seeds at the completion of their PSI. On average, 25.7 ± 9.9% of ordered seeds were not implanted. Excess seeds were separated into two categories, accounted‐for excess, determined by the four normalization factors, and residual excess, assumed to be due to overordering. The upper 99.9% CI linear fit of the normalized clinical data plus a 5% “cushion” may provide a more reasonable nomogram for 103Pd seed ordering for our institution. Nomograms customized for individual institutions may reduce seed waste, thereby reducing radiation safety risks and increasing the value of prostate brachytherapy.
ISSN:1526-9914
1526-9914
DOI:10.1002/acm2.12404